AB0373 ABATACEPT IN MONOTHERAPY OR IN COMBINATION WITH CONVENTIONAL DISEASE-MODIFYING DRUGS: TREATMENT PERSISTENCE IN A COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS.
Authors: P. Muñoz Reinoso, I. García Hernández, B. Hernández-Cruz, J. J. Pérez Venegas
Journal: Annals of the Rheumatic Diseases (2022)

Background Abatacept is a selective T-cell co-stimulation modulator indicated for the treatment of moderate to severe active rheumatoid arthritis in patients with inadequate response to previous treatment. It is used in routine clinical practice in combination with other conventional synthetic disease-modifying drugs, with some records showing worse results when used in monotherapy 1 . Objectives To analyse the persistence and efficacy of ABA in monotherapy vs. combined with conventional DMARDs. To determine the prescription patterns and clinical characteristics of patients who have received at least one dose of the drug. Methods Retrospective observational study of a cohort of RA patients under treatment with ABA reviewed in Rheumatology consultations at Virgen Macarena University Hospital, from 2010 to 2020. STATA statistical software was used. The study was conducted in accordance with the standards of the CEIC. Results 69 patients were included, 80% female. The average age was 63 (53-63) years. RA evolution time was 10 (4-16) years. 92% RF +, 86% ACCP + and 84% double +. 81% with erosions and 47% had extra-articular manifestations: 16 ILD, 10 Dry Syndrome and 9 Rheumatoid Nodules. 96% had relevant comorbidities such as Osteoporosis 33, Hypertensión 31, dyslipidaemia 26, Fibromyalgia 16, Depression 14 or Diabetes 9. Prior to ABA start, all were treated with NSAIDs, GC and conventional DMARDs, 32% with one conventional DMARDs, 31% with two and 37% with three or more; The conventional DMARDs used were MTX 90%, LFN 45%, HCQ 38%, CyA 13%, Gold salts 9% and SSZ 7%. 71% were previously treated with biologic DMARDs; 44% with one biologic DMARDs and 39% with two or more biologic DMARDs. The most commonly used biologic DMARDs were ETA 63.3%, ADA 30.6%, IL-6 inhibitors 20.4% and RTX 24.3%. Of the 29% who started ABA as a first-line. S.C. administration was used in 78%, with the standard dose. ABA was introduced together with conventional DMARDs in 67% patients: MTX 70%, LFN 17%, HCQ 13%, SSZ 4%. Of the 16 patients with ILD, 9 continued with conventional DMARDs in combination. The average ABA persistence was 65.5 (43-100) months; monotherapy 56 (17-76) and associated with conventional DMARDs 73 (59-101), p=0.904 (Figure 1). The differences between ABA in monotherapy or in combination are shown in Table 1. On the last visit, 67% patients with ABA had CG. At the end of the study 38% remained on ABA; 62% discontinued treatment, 68% due to secondary failure, 16% primary failure and 12% adverse events (skin toxicity, haematological toxicity and infections). Six patients died, four due to disease complications, five of whom were on monotherapy. Table 1. Variables Global n=69 ABA monotherapy n=23 ABA + conventional DMARDs n=46 Median (p25-p75) Age 63 (54 – 70) 70 (63 – 74) 57 (52 – 67) 0,001 Duration of illness 10 (7 – 16) 12 (5 – 20) 10 (4 – 19) 0,04 Exposure time 66 (43 – 100) 56 (20 – 76) 73 (59 – 106) 0,04 DAS28 Basal 4.9 (3.9 - 5.7) 5.3 (3.8 – 6.3) 4.8 (3.8 – 5.5) 0,1 DAS28 Final 4.2 (2.8 – 5.6) 4 (2.7 – 5.4) 4.7 (2.8 – 5.7) 0.4 Basal GC (mg/d) 6 (5 – 10) 6 (5 – 11) 6 (5 – 10) 0,5 Final GC 6 (5 – 10) 7 (5 – 10) 6 (5 – 10) 0,4 n (%) ABA as a first-line 20 (29) 6 (26) 14 (30) 0,7 ABA + GC at the start 54 (78) 18 (78) 319 (63) 1 At the end 31 (67) 12 (75) 6 (78) 0,4 ABA Discontinuation 43 (62) 13 (57) 30 (65) 0,4 ABA Persistence 26 (38) 10 (43) 16 (35) 0,4 EULAR response None 32 (64) 11 (64) 21 (63) 0,9 Moderate 11 (22) 4 (23) 7 (21) Good 7 (14) 2 (12) 5 (15) Figure 1. Conclusion The results show that Abatacept is mainly used after failure of conventional DMARDs and biologic DMARDs, in patients with long-standing RA and poor prognostic criteria. Combination therapy is used in patients with a higher risk profile (males, antibody positivity, erosions, extra-articular manifestations, comorbidity) and leads to a reduction in the number of patients treated with GC. Survival of ABA in combination is higher than in monotherapy, but this difference is less statistically significant when adjusted by age and gender. References [1]Blair HA, et al. Abatacept: A Review in Rheumatoid Arthritis. Drugs. 2017;77(11):1221-33. Disclosure of Interests None declared